In an effort to cut down on some patients’ return trips to the emergency room, some discharged patients now go home armed with a new tool, one you’d expect to see with a college student, rather than a patient leaving the hospital: a tablet.
Often when heart failure patients are discharged, they receive a list of instructions to keep in good health: eat less sodium, lose so much weight, make a follow up appointment, etc. But, to many patients and their families the list can seem daunting. Anne Norris, MD, chief medical officer of Penn Home Care and Home Infusion Therapy, said the tablet gives them confidence as they now have daily contact with their care staff.
Each morning the patients answer a few questions about their health and how they feel. They’re also equipped with gear like a scale and blood pressure cuff which syncs effortlessly with the device and sends that data back to nurses in the Penn Elert office, who are on hand to make sure everything is going as planned.
The tablets are set up to send and receive text messages, so if that info isn’t received by 11 a.m. or so, Elert nurses here can reach out directly and check in. Norris said the patients really love this aspect of the program. Some patients will send even send back emojis and show off their technical prowess to their grandchildren.
“It’s surprising how comfortable people are with this. They’ve grown into tablet technology… the touch screen, the pop-ups,” Norris said. “They love it.”
The staff here at Penn can use that daily data to spot any trends before they become problems. From there, they have a lot of options, including contacting the patient or family member, the patient’s doctor or home care nurse. They can even send a Penn Home Infusion nurse to the patient’s home to give IV diuretics. In addition to day-to-day health oversight, this telehealth program allows the Elert nurses to coach patients in home management of heart failure. Over time, patients learn what the signs of worsening heart failure are, what role diet and fluid intake have, and the best way to fit their medicines into daily life in a way that helps them feel well at home and stay out of the hospital.
Norris said this method of telemonitoring began here at Penn Medicine for heart failure patients, and has now moved on to using it for liver, transplant and cancer patients.
Heart failure patients across Penn have about an 18 percent 30 day readmission rate, Norris said, but those equipped with the tablets come back just nine percent of the time. Readmission rates for patients in the other disease groups like cancer and liver disease are reduced also.
Despite its success in lowering hospital readmissions, challenges for the program exist. Penn Care has just 105 of the tablets available with the required software and just two nurses monitoring 7 days a week.
“We have to make decisions about who gets this scarce resource,” Norris said. “We’d love to be able to provide this technology to a much wider swath of the patients, with many other kinds of medical problems.”
With more resources, Norris said they’d be able to expand with more devices, more nurses here at Penn to handle the communications and more space. In fact, all of the technology is there for nurses to video chat with the patients, but they simply don’t have a private space to do it right now.
A big hurdle is that, currently, the program isn’t billable to insurers. Fixing that, Norris said, would go a long way in helping them expand.
“Patients love telehealth. They have access to someone that they have developed a real a relationship with,” Norris said. “Family members love it because they have expert support, seven days a week, even when they cannot be with their loved one.”